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There is a need for researchers to have easy reference to the wide spectrum of different types of quality of life (QoL) instruments that can be used in atopic dermatitis ( AD). Previous reviews on QoL in AD do not cover the full spectrum of QoL measures used in studies on AD. This study, on behalf of the European Academy of Dermatology and Venereology ( EADV) Task Force on QoL, contains information on instruments available for health-related QoL and family QoL assessment in AD including information on validation, experience of QoL assessment in AD for different purposes, peculiarities of QoL assessment in different age groups, expert analysis of available instruments including data on limitations of their use and recommendations of the Task Force. [ABSTRACT FROM AUTHOR]

Atopic dermatitis ( AD) is a clinically defined, highly pruritic, chronic inflammatory skin disease of children and adults. The diagnosis is made using evaluated clinical criteria. Disease activity is best measured with a composite score assessing both objective signs and subjective symptoms, such as SCORAD. The management of AD must consider the clinical and pathogenic variabilities of the disease and also target flare prevention. Basic therapy includes hydrating topical treatment, as well as avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment of visible skin lesions is based on topical glucocorticosteroids and the topical calcineurin inhibitors tacrolimus and pimecrolimus. Topical calcineurin inhibitors are preferred in sensitive locations. Tacrolimus and mid-potent steroids are proven for proactive therapy, which is long-term intermittent anti-inflammatory therapy of the frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is indicated for severe refractory cases. Biologicals targeting key mechanisms of the atopic immune response are promising emerging treatment options. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) may diminish pruritus, but do not have sufficient effect on lesions. Adjuvant therapy includes UV irradiation, preferably UVA1 or narrow-band UVB 311 nm. Dietary recommendations should be patient specific and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. 'Eczema school' educational programmes have been proven to be helpful for children and adults. [ABSTRACT FROM AUTHOR]

The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. It is based on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment is used for exacerbation management. Topical corticosteroids remain the first choice. Systemic anti-inflammatory treatment should be kept to a minimum, but may be necessary in rare refractory cases. The new topical calcineurin inhibitors (tacrolimus and pimecrolimus) expand the available choices of topical anti-inflammatory treatment. Microbial colonization and superinfection (e.g. withStaphylococcus aureus,Malassezia furfur) can have a role in disease exacerbation and can justify the use of antimicrobials in addition to the anti-inflammatory treatment. Evidence for the efficacy of systemic antihistamines in relieving pruritus is still insufficient, but some patients seem to benefit. Adjuvant therapy includes ultraviolet (UV) irradiation preferably of UVA wavelength; UVB 311 nm has also been used successfully. Dietary recommendations should be specific and only given in diagnosed individual food allergy. Stress-induced exacerbations may make psychosomatic counselling recommendable.‘Eczema school’ educational programmes have proved to be helpful. [ABSTRACT FROM AUTHOR]

Presents abstracts of research papers on dermatology presented to the European Academy of Dermatology and Venereology. "Sunflower oleodistillate a new natural PPAR-alpha activator with anti-inflammatory properties," by L. Dubusquoy, N. Piccardi, P. Msika, J. Auwerx and P. Chambon; "Tacrolimus ointment reduces immunoflogosis in atopic dermatitis," by M. Caproni, D. Torchia, E. Antiga, W. Volpi, E. Del Bianco and P. Fabbri; "Increased expression and a potential anti-inflammatory role of TRAIL in atopic dermatitis," by E. Vassina, M. Leverkus, L. R. Braathen, H.-U. Simon and D. Simon.

Background: The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. Objective: To evaluate the reaction frequency and the reaction profiles of 10 until mid‐2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. Methods: A retrospective data analysis of patients with suspected aeroallergen‐dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology‐associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. Results: The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. Conclusion: The aeroallergen patch test is a useful add‐on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors (TCIs), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD, it is important to involve experts to obtain their opinion on its optimal treatment. Objective: Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCIs in the treatment of AD, with a focus on the differentiation between tacrolimus and pimecrolimus. Methods: Six expert dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July–September 2017) and a face‐to‐face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD; and (ii) TCIs in AD. Hot topics in the treatment of AD not supported by meta‐analysis, clinical trials or large observational studies were also discussed based on clinical experience. Results: In total, 25 consensus statements were defined and validated: eight statements on the general background of AD and 17 statements on the use of TCIs in AD, including their mechanism of action and therapeutic indications in AD, efficacy in adult and paediatric AD patients, pharmacokinetics, incidence of adverse events and safety concerns. Hot topics on the use of TCIs for the treatment of AD included cream vs. ointment, dosages, TCIs contact allergy, burning sensation management, superinfection and vaccination concerns. Conclusion: Topical calcineurin inhibitors are a suitable therapy for AD, and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus. [ABSTRACT FROM AUTHOR]

Background: There are few population‐based studies assessing the prevalence of skin diseases. Objectives: To estimate the prevalence of five chronic skin inflammatory diseases, i.e. atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo and hidradenitis suppurativa (HS) in France, using validated self‐diagnostic questionnaires. Methods: Population‐based study using a representative sample of the French general population aged more than 15 years and sampling with replacement design. All participants were asked (ii) to fill in a specific questionnaire including socio‐demographic characteristics, (ii) to declare if they have been diagnosed with one or more skin problem or skin diseases during their life, and (iii) to fill in five validated self‐reported questionnaires for AD, psoriasis, AA, vitiligo and HS. Results: A total of 20.012 adult participants responded to the questionnaire of whom 9760 were men (48.8%) and 10.252 (51.2%) were women. We identified a prevalence of 4.65% for AD (931 individuals), 4.42% for psoriasis (885 individuals), 1.04% for AA (210 individuals), 0.46% for vitiligo (93 individuals) and 0.15% for HS (29 individuals), respectively. Limitations: Questionnaire‐based study and possible disease misclassifications. Conclusion: This is the largest population‐based study aiming to estimate the prevalence of five chronic skin inflammatory diseases. [ABSTRACT FROM AUTHOR]

Abstract: Background: Concomitant allergic contact dermatitis (ACD) has been described as a possible cause of atopic dermatitis (AD) becoming difficult‐to‐treat. However, contact sensitization in this patient group has barely been studied. Objective: To study the occurrence of ACD in a population of difficult‐to‐treat AD children and adults. Methods: Clinical and patch test information of 48 patients with difficult‐to‐treat AD unresponsive to conventional outpatient treatments was gathered retrospectively. We studied prevalence and relevance of common allergens, performed dynamic patch test analysis and assessed occurrence of polysensitization. Results: In 48 patients with difficult‐to‐treat AD, 75% (n = 36/48) had a concomitant contact allergy, and 39% (n = 14/36) of these patients were polysensitized. ACD and polysensitization prevalences were equal amongst children and adults. The most frequent and relevant reactions were seen against wool alcohols, surfactants cocamidopropyl betaine and dimethylaminopropylamine, bichromate and fragrance mix I. Dynamic pattern analysis showed these reactions to be mostly allergic and not irritative of nature. Conclusion: Difficult‐to‐treat AD patients frequently suffer from concomitant (multiple) contact allergies, and this may be a reason why the AD turns into a difficult‐to‐treat disease. Awareness of this phenomenon is necessary, as pragmatic implementation of allergen avoidance strategies may be helpful in getting disease control in this population. [ABSTRACT FROM AUTHOR]

Background Prurigo nodularis Hyde (PN) is a highly pruritic condition due to a vicious circle of repeated itching and scratching. There are no representative clinical studies investigating comorbidities in a large collective of PN patients. Objective This pilot study aimed to investigate the exact distribution of the coexisting diseases in a large representative consecutive cohort of PN patients. Methods A total of 108 PN patients (36.1% male; mean age of 61.5 ± 16.7 years) were enrolled in the study. Results In 87.0% of patients, diseases underlying PN could be established (18.5% skin disease, 7.4% systemic origin, 1.8% neurological diseases, 59.3% mixed origin). Due to several possible causative co-factors, the majority of patients were classified in the group of mixed origin (59.3%). In 53.1% of these patients, at least one dermatological factor was involved in the induction of PN. Interestingly, nearly half (46.3%) of all PN patients had either an atopic predisposition or atopic dermatitis as a single cause of PN (18.5%) or as one co-factor of PN of mixed origin (27.8%). Considering the different underlying diseases, there was no significant age or gender difference. Conclusion PN does not seem to represent a characteristic symptom of one disease only. Multiple pruritogenic diseases are linked to evolution and improvement of PN upon treatment. Atopic predisposition is a major factor in nearly half of PN patients. The large collective of the present study helped detect a broad range of underlying diseases and thus to provide recommendations for rational diagnostics. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) and psoriasis are chronic skin conditions. Local or systemic treatments are effective, but their effects are transient. Hydrotherapy, used alone or in combination with other treatments, could be considered as one form of care in providing effective management of these dermatoses. The objective of this observational study was to evaluate the benefit of a 3-week treatment at Avène Hydrotherapy Centre in a very large cohort of patients suffering from atopic dermatitis and psoriasis and to assess the treatment benefits on patients undergoing hydrotherapy for two consecutive years. This 8-year observational study analysed 14 328 records of patients having a dermatological disease and who came to Avène Hydrotherapy Centre for a 3-week treatment between 2001 and 2009. Among them, patients were suffering from atopic dermatitis ( n = 5916) and psoriasis ( n = 4887). On admission on D0 (day 0) and at the end of cure on D18 (day 18), the severity of AD and psoriasis were evaluated by SCORing Atopic Dermatitis (SCORAD) and Psoriasis Area and Severity Index (PASI), respectively. In order to assess the cumulative effect of the hydrotherapy treatment, the evolution of SCORAD or PASI of patients who came 2 years in a row was also calculated. A significant improvement in SCORAD was observed between D0 and D18 (−41.6%) ( P < 0.0001) and similarly, a significant reduction in PASI was noted between D0 and D18 (−54.4%) ( P < 0.0001) after 3-weeks of hydrotherapy. PASI 50 and PASI 75 were 64.3% and 19.5%, respectively. For atopic patients ( n = 1102) or patients suffering from psoriasis ( n = 833) who came for two consecutive years, a significant SCORAD and PASI improvement was observed on D0 of the second year when compared with D0 of the previous year ( P < 0.0001). This study is the first observational study in such a large cohort demonstrating the benefit of a 3-week treatment at the Avène Hydrotherapy Centre for atopic and psoriatic patients. [ABSTRACT FROM AUTHOR]

Background The dermatological becoming of children presenting with atopic dermatitis (AD) is not well known. Objective We performed a study on the presence of AD and other dermatological diseases in subjects with a previous history of AD. Methods An opinion poll was conducted in eight countries through a telephone interview: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. Results Among 4369 interviewees, 12.25% declared a history of AD in infancy and 12.4% declared to suffer from a dermatological disease (27% of patients had a history of AD and 10.3% did not have it). Current declared cases of atopic eczema or contact eczema were more frequent in patients with previous history of AD (39.3% vs. 21.5%), whereas these patients appeared less affected by rosacea (2.9% vs. 7.9%). Some differences were observed between different countries. Conclusion The main interests of this study are the large number of subjects, originating from eight different countries, and its focus on the dermatological future of patients with AD, which is not limited to AD itself. [ABSTRACT FROM AUTHOR]

Background Periocular contact dermatitis may appear as contact conjunctivitis, contact allergic and/or irritative eyelid and periorbital dermatitis, or a combination of these symptoms. The clinical symptoms may be induced by several environmental and therapeutic contact allergens. Objectives The aim of the present study was to map the eliciting contact allergens in 401 patients with periocular dermatitis (PD) by patch testing with environmental and ophthalmic contact allergens. Methods Following the methodics of international requirements, 401 patients were tested with contact allergens of the standard environmental series, 133 of 401 patients with the Brial ophthalmic basic and supplementary series as well. Results Contact hypersensitivity was detected in 34.4% of the patients. Highest prevalence was seen in cases of PD without other symptoms (51.18%), in patients of PD associated with ophthalmic complaints (OC; 30.4%), and PD associated with atopic dermatitis (AD; 27.9%). In the subgroup of PD associated with seborrhoea (S) and rosacea (R), contact hypersensitivity was confirmed in 17.6%. Most frequent sensitisers were nickel sulphate (in 8.9% of the tested 401 patients), fragrance mix I (4.5%), balsam of Peru (4.0%), paraphenylendiamine (PPD) (3.7%), and thiomersal (3.5%). By testing ophthalmic allergens, contact hypersensitivity was observed in nine patients (6.7% of the tested 133 patients). The most common confirmed ophthalmic allergens were cocamidopropyl betaine, idoxuridine, phenylephrine hydrochloride, Na chromoglycinate, and papaine. Limitations Patients with symptoms of PD were tested from 1996 to 2006. Conclusions The occurence of contact hypersensitivity in PD patients was in present study 34.4%. A relatively high occurence was seen in cases of PD without other symptoms, in PD + OC and in PD + AD patients. The predominance of environmental contact allergens was remarkable: most frequent sensitizers were nickel sulphate, fragrance mix I, balsam of Peru, thiomersal, and PPD. The prevalence of contact hypersensitivity to ophthalmic allergens did not exceed l.5%. Conflicts of interest None declared [ABSTRACT FROM AUTHOR]

Background The increase in the incidence of atopic dermatitis (AD) in developed countries has been related to familiar and environmental factors. This survey was undertaken to investigate the family background, birthweight and the home environment of children suffering from AD in order to point out the possible factors that provoke the development of the disease. Methods The study uses data collected by means of self-administered questionnaires and discusse s 461 cases of children (age 0–12) with active skin signs of AD. The control group comprised of 343 children (age 0–12) with no skin signs or positive lifetime history of AD. Associations between familiar and various home environmental factors and the risk of AD were calculated by means of odds ratios. Results There were statistically significant positive associations between atopic eczema symptoms and higher birthweight, small households, wall-to-wall carpets, as well as indoor-kept pets. Day-nursery attendance, heating system and indoor smoking, however, did not significantly alter the risk of the disease. Conclusions Because of the limitations of a retrospective questionnaire study, further research is needed to confirm these associations and clarify whether they are causative. [ABSTRACT FROM AUTHOR]

In order to obtain background references when dealing with serum eosinophil cationic protein (s-ECP) measurements in children with allergic diseases, population-based studies are important. The objectives of our study were to explore the strength of associations between the s-ECP level and atopic dermatitis (AD), allergic rhinitis (AR) and asthma in an unselected northern Norwegian schoolchildren population.s-ECP was sampled from 396 schoolchildren aged 7–12 years from Sør-Varanger community, northern Norway as a part of a population-based study of allergy. In advance, anamnestic information concerning a history of AD, AR and asthma were obtained. The children underwent a clinical investigation, including skin prick tests and peak expiratory flow measurements, where the presence of AD, AR and asthma were evaluated. The associations of these diseases to the s-ECP values were examined in bivariate statistical analysis.No statistical significant associations were detected in bivariate analysis between s-ECP and AD, AR or asthma: the mean s-ECP in children without self-reported AD/AR/asthma was 4.6 µg/L[95% confidence interval (CI) 4.0–5.2]. The mean s-ECP in children with self-reported AD or AR or asthma was 5.2 µg/L (95% CI 4.1–6.2), 4.6 µg/L (95% CI 3.5–5.7) and 6.4 µg/L (95% CI 4.4–8.3), respectively. The highest mean s-ECP level was measured in children with clinically diagnosed asthma; 7.1 µg/L (95% CI 4.0–10.3). Above the 75-percentile level of s-ECP, only 17.2% of the children had a history of asthma.In this unselected children population, the occurrence of AD or AR was not reflected by an increase in the s-ECP level. The s-ECP was increased in children with asthma, but was not statistically significant. Furthermore, the majority of children with high s-ECP values were not asthmatics. We conclude that the associations between s-ECP and allergic diseases are weak in an unselected population of children. [ABSTRACT FROM AUTHOR]

In atopic dermatitis the inflammatory reaction is quantified either clinically or histologically. While clinical evaluation has the major disadvantage of inter- and intraoperator variance, histological investigation requires invasive procedures. Therefore, standard techniques which provide both an objective and non-invasive form of examination are desirable. We investigated 20 patients with atopic dermatitis by means of high resolution 20-MHz b-scan ultrasound. Investigations were performed on inflammatory skin lesions at regular intervals using a standardized combination of external treatment with α-methyl-prednisolonaceponat ointment and UV-A/UV-B phototherapy until the lesions had healed. Skin colour (erythema) was assessed with the Minolta Chromameter CR 200 colorimeter according to the L*a*b* colour system. Sonograms of affected skin show a zone of low ecohogenicity below the so-called entry-echo. We refer to this as the echolucent area. Healing of a lesion is seen as a decrease in thickness and an increase in density of the skin in the sonographic image; the echolucent area disappears totally when the lesion has clinically healed. In five patients we excised small areas of skin to compare the sonographic and histological pictures of exactly the same site. This showed that the thickness of the subepidermal ecoholucent area corresponds to the inflammatory reaction representing both edema and cellular infiltration. Comparing the finding in sonography with the change in skin colour measurements we found that the a*-value of the L*a*b* colour system representing redness correlated well with the sonographic density of the ecoholucent area. In conclusion, 20-MHz-b-scan sonography and colorimetry are suitable methods for non-invasive, objective evaluation of the inflammatory process in atopic dermaitits. [ABSTRACT FROM AUTHOR]

Methylprednisolone aceponate is a new potent topical corticosteroid. Chemically it is a corticoid diester that rapidly penetrates the skin. It is rapidly metabolised and then conjugated so that although potent, it does not appear to cause serious local or systemic side effects. Clinical trials indicate that once daily applications are sufficient to control most eczematous disorders and that it is suitable and effective in atopic dermatitis. [ABSTRACT FROM AUTHOR]